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Atluri VV, Mahadevuni V, Ganta AR, Kumar VRS. Atraumatic Bilateral Patellar Tendon Rupture: A Case Report. J Orthop Case Rep 2025; 15:115-120. [PMID: 40092254 PMCID: PMC11907140 DOI: 10.13107/jocr.2025.v15.i03.5354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 01/23/2025] [Indexed: 03/19/2025] Open
Abstract
Introduction Bilateral patellar tendon rupture is an uncommon reason for extensor mechanism dysfunction. Various predisposing factors, including systemic diseases and the use of steroids or antibiotics, can elevate the risk. The patient typically presents with an inability to extend the knee, generalized pain and swelling, and a high-riding patella observed on lateral radiographs. Case Report We report a case involving a 44-year-old man with no underlying risk factors or systemic disease who sustained a bilateral patellar tendon rupture following minor trauma. The patient was treated with bilateral primary transosseous end-to-end tendon repair, followed by a brief period of immobilization and an intensive rehabilitation program. Six months post-surgery, he could walk unassisted without pain, regain full range of motion in both knees, and carry out daily activities without limitations. Conclusion Timely diagnosis and immediate surgical intervention are crucial to preventing complications related to extensor mechanism failure and ensuring favorable functional outcomes.
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Affiliation(s)
- Venkata Vinay Atluri
- Department of Orthopaedics, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India
| | - Vishwanath Mahadevuni
- Department of Orthopaedics, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India
| | - Akhilesh Reddy Ganta
- Department of Orthopaedics, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India
| | - V R Sujit Kumar
- Department of Orthopaedics, Mamata Academy of Medical Sciences, Hyderabad, Telangana, India
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2
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Franco H, Fraser D. Spontaneous Bilateral Patellar Tendon Rupture in Patient with Ehlers-Danlos Syndrome: A Case Report. J Orthop Case Rep 2024; 14:124-129. [PMID: 39381280 PMCID: PMC11458247 DOI: 10.13107/jocr.2024.v14.i10.4834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/14/2024] [Indexed: 10/10/2024] Open
Abstract
Introduction Bilateral spontaneous patellar tendon ruptures are rare, though it is hypothesized to be more common in patients with risk factors such as connective tissue disorders such as Ehlers-Danlos syndrome (EDS), systemic disorders weakening collagen structures, chronic stress around the patellar tendon, medications, and obesity or sedentary lifestyles. Clinicians should maintain a high degree of clinical suspicion for concerning features on clinical examination and radiological investigations to facilitate prompt diagnosis and operative management. This case report describes the first documented case of an adult patient with EDS who sustained bilateral spontaneous patellar tendon ruptures. There is one previously reported acute bilateral patellar tendon rupture occurring in a pediatric patient with EDS. Within the adult literature, two case reports have reported patients with EDS: One acute unilateral patellar tendon rupture who underwent operative management and one chronic patellar tendon tear requiring reconstruction 2.5 years following initial end-to-end repair. Case Report A 45-year-old male sustained bilateral patellar tendon ruptures after falling onto his knees while pushing a heavy cart. The patient reported a giving-way sensation and was unable to mobilize independently. On presentation to the emergency department, the patient was noted to have an absent straight-leg raise and a palpable gap between the distal pole of the patella and patellar tendon. Plain radiograph and ultrasound investigations confirmed bilateral complete patellar tendon ruptures. The patient underwent operative management 5 days following injury through bilateral direct patellar tendon repair utilizing the Krackow technique with transosseous fixation. Twelve months post-operatively, the patient had returned to pre-injuries activities of daily living, a full active range of motion without extensor lag, and recorded "fair knee function" on the Lysholm Knee Scoring Scale. Conclusion This case report described the first reported bilateral spontaneous patellar tendon rupture in an adult patient with EDS, who underwent operative management and achieved a return to pre-injury function. Furthermore, this case report summarizes the pre-existing literature on spontaneous bilateral patellar tendon ruptures and patellar tendon ruptures in patients with EDS.
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Affiliation(s)
- Helena Franco
- Department of Orthopaedic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - David Fraser
- Department of Orthopaedic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
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3
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Flores Meca A, Sánchez López R, Tapia Fernández PJ. Acute carpal tunnel syndrome after atraumatic rupture of the flexor tendons: a case report. CURRENT ORTHOPAEDIC PRACTICE 2024; 35:260-263. [DOI: 10.1097/bco.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Acute carpal tunnel syndrome (ACTS) is a rare entity, mainly associated with traumatic causes, although patients with predisposing factors such as taking anticoagulants or tendinopathies may debut with an atraumatic ACTS. This case study presents the case of a 77-year-old male patient, anticoagulated, who began with rapidly progressive pain and swelling in the right wrist, radiating towards the medial territory, with no history of traumatic triggering event. Examination showed paraesthesia in the volar aspect of the first to third fingers of the hand and increased pain on passive mobilisation of the fingers. Given the progressive evolution of the condition and the lack of response to both physical and pharmacological measures, the carpal tunnel was opened surgically. During surgery, a significant haematoma was observed secondary to the rupture of the deep flexor tendons of the fourth and fifth fingers inside the canal. Following release of the carpal tunnel, complete recovery of the symptomatology occurred. In conclusion, a high degree of clinical suspicion is necessary in a patient with an examination suggestive of ACTS. The treatment of choice is urgent surgical decompression of the carpal tunnel. Early intervention allows resolution of symptoms and reduces complications.
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Edge CC, Widmeyer J, Protzuk O, Johnson M, O’Connell R. Gouty destruction of a patellar tendon reconstruction and novel revision reconstruction technique: A case report. World J Orthop 2024; 15:675-682. [PMID: 39070936 PMCID: PMC11271696 DOI: 10.5312/wjo.v15.i7.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Gout is a disease characterized by hyperuricemia, and resultant deposition of uric acid crystals in tissues. While typically manifested as intraarticular crystals or tophi, gout can also cause pathology at entheses. Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture. Furthermore, allografts can also be at risk of rupture in the setting of severe gout. We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction. CASE SUMMARY A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs. She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years. This patient presented with pain and extensor lag. A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle. The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction. She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks. At twelve weeks, she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises. CONCLUSION Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.
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Affiliation(s)
- Carl C Edge
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Jonathan Widmeyer
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Omar Protzuk
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Maya Johnson
- Department of Orthopaedic Surgery, Division of Sports Medicine, Virginia Commonwealth University Health System, Richmond, VA 23298-0153, United States
| | - Robert O’Connell
- Division of Sports Medicine, Orthowest, Carrolton, GA 30117, United States
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Fernandes A, Rufino M, Hamal D, Mousa A, Fossett E, Cheema KS. Simultaneous Bilateral Patellar Tendon Rupture: A Systematic Review. Cureus 2023; 15:e41512. [PMID: 37426403 PMCID: PMC10327612 DOI: 10.7759/cureus.41512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/11/2023] Open
Abstract
The extensor mechanism of the knee can be damaged due to various modes of injury, which, in most cases, will require urgent surgical intervention for repair. Single patellar tendon ruptures are uncommon, but simultaneous bilateral events are even rarer and have been scarcely reviewed in English literature. Research in this area is mainly confined to case series, with some literature reviews but no evidence of more substantial analysis. Therefore, this systematic review was done to analyse the existing literature on bilateral simultaneous patellar tendon ruptures and propose a systematic and standardised approach to diagnosing and managing these injuries. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search terms included 'bilateral patellar tendon rupture', 'bilateral', 'patellar', 'tendon' and 'rupture'. Three independent reviewers conducted searches in PubMed, OvidSP for Medline, Embase and the Cochrane Library using the same search strategy. The eligibility criteria included studies on bilateral concomitant patellar tendon rupture published in English. Bilateral simultaneous patellar tendon ruptures of traumatic and atraumatic origin in human patients were included. The study types comprised case reports and literature reviews. The key limitation of this study was the low number of patients covered by the eligible literature. Patellar tendon ruptures are a rare and scarcely documented injury, and there is a need for studies with a high level of evidence, especially regarding surgical treatment choice and methods, as well as post-operative management, which could potentially lead to improved outcomes in the management of this injury.
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Affiliation(s)
- André Fernandes
- Trauma and Orthopaedics, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, GBR
| | - Mariana Rufino
- Respiratory Medicine, Wirral University Teaching Hospital NHS Foundation Trust (WUTH), Wirral, GBR
| | - Divakar Hamal
- Anesthesiology, Hull University Teaching Hospital, Hull, GBR
| | - Amr Mousa
- Surgery, The Hillingdon Hospital NHS Foundation Trust, London, GBR
| | - Emma Fossett
- Trauma and Orthopaedics Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
| | - Kamalpreet S Cheema
- Trauma and Orthopaedics Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, GBR
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Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10061011. [PMID: 35742062 PMCID: PMC9222654 DOI: 10.3390/healthcare10061011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Osgood-Schlatter disease is the most common osteochondritis of the lower limb in sport-practicing children and adolescents. Its manifestation usually coincides with the appearance of the secondary ossification center of the tibia and is linked to the practice of sports with an explosive component. In the present study, a review of the factors related to its appearance, diagnosis and treatment was carried out. Its appearance seems to be multifactorial and related to multiple morphological, functional, mechanical and environmental factors. Given all the above, risk factor reduction and prevention seem the most logical strategies to effectively prevent the appearance of the condition. In addition, it is essential to create prevention programs that can be objectively assessed and would allow to stop the progress of the pathology, particularly in those sports where high forces are generated on the insertion zone of the patellar tendon at sensitive ages. More studies are needed to clarify which type of treatment is the most appropriate—specific exercises or the usual care treatment.
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7
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Fredericks DR, Slaven SE, McCarthy CF, Dingle ME, Brooks DI, Steelman TJ, Donohue MA, Griffin DW, Giuliani JR, Dickens JF. Incidence and Risk Factors of Acute Patellar Tendon Rupture, Repair Failure, and Return to Activity in the Active-Duty Military Population. Am J Sports Med 2021; 49:2916-2923. [PMID: 34313493 DOI: 10.1177/03635465211026963] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar tendon ruptures have a reported incidence of 0.68 per 100,000 person-years in the general population. The epidemiology of surgically treated patellar tendon ruptures in the US military has yet to be reported, which would provide opportunity for identification of risk factors for these otherwise healthy and active patients. PURPOSE To determine the incidence of patellar tendon rupture in the Military Health System (MHS) population and to analyze demographic patterns, surgical fixation methods, and rerupture rates. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We utilized the MHS Data Repository (MDR) to identity active-duty military servicemembers surgically treated for patellar tendon rupture between 2010 and 2015. Records were reviewed for demographic information, injury characteristics, fixation technique, and occurrence of rerupture. Risk factors for rupture were calculated using Poisson regression based on population counts and demographic data obtained in the MDR. Risk factors for rerupture and return to duty were analyzed via univariate analysis and multivariate regression. RESULTS A total of 504 operatively treated primary patellar tendon repairs in 483 patients were identified, with an overall incidence of 6 per 100,000 person-years. Mean age was 33.6 years (range, 17-54 years) and 98% of patients were male. Fixation method was 81% bone tunnels and 7% suture anchors, and 12% were unknown. Black race had a higher relative rate ratio for rupture compared with the race categories White (9.21; P < .0001) and Other (3.27; P < .0001). The rupture rate was higher in 35- to 44-year-old patients compared with those aged 18 to 24 years (P < .0001), 25 to 34 years (P < .0001), and 45 to 64 years (P = .004). Return to full previous level of activity occurred in 75.8% of patients, 14.6% returned to activity with limitations, and 9.5% were medically separated. The rerupture rate was 3%. Fixation method, tobacco usage, body mass index, and race were not significant risk factors for rerupture. CONCLUSION The incidence of patellar tendon rupture in the US military population is substantially higher than has been reported in the civilian population. Among military personnel, men, Black servicemembers, and those aged 35 to 44 years were at highest risk for patellar tendon rupture. Three-quarters of patients were able to return to full activity without limitations. The rerupture rate was low and unaffected by fixation method.
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Affiliation(s)
- Donald R Fredericks
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sean E Slaven
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Conor F McCarthy
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Marvin E Dingle
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Daniel I Brooks
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA
| | - Theodore J Steelman
- Fort Belvoir Community Hospital, Department of Orthopaedic Surgery, Fort Belvoir, Virginia, USA
| | - Michael A Donohue
- John A. Feagin Jr. Sports Medicine Fellowship at West Point, West Point, New York, USA
| | - Daniel W Griffin
- Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois, USA
| | | | - Jonathan F Dickens
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,John A. Feagin Jr. Sports Medicine Fellowship at West Point, West Point, New York, USA
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8
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Simultaneous Bilateral Rupture of the Patellar Tendon and Medial Collateral Ligament: A Case Report and Literature Review. Case Rep Orthop 2020; 2020:8862600. [PMID: 33133714 PMCID: PMC7593758 DOI: 10.1155/2020/8862600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 01/16/2023] Open
Abstract
Bilateral rupture of the patellar tendon is considered an uncommon and rare musculoskeletal injury. The association of this lesion with medial collateral ligament tear appears to be exceedingly rare. We present the case of a combined rupture of the medial collateral ligament (MCL) and the patellar tendon of both knees in a 48-year-old man, after falling 2 meters down an embankment. While there are numerous publications concerning associated MCL tears and other knee ligaments, a combination of MCL tear with a patellar tendon rupture is very rare. In addition, our case presents the first case recorded in the literature, involving both knees of a patient. The clinical case is described and discussed following a review of the literature. The symmetrical knee injury was treated with a primary direct repair of the MCL tears and using a suture anchor fixation of the patellar tendon ruptures, which was reinforced by a stainless steel wire and an autograft of the ipsilateral quadriceps tendon.
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9
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Sekiguchi T, Hagiwara Y, Honda M, Itoi E. Bifocal Disruption of the Patellar Tendon with Avulsion of the Tibial Tuberosity: A Case Report. Open Orthop J 2020. [DOI: 10.2174/1874325002014010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Introduction:
Bifocal disruption of the knee extensor system is rare. Coincident bifocal proximal and distal disruptions of the patellar tendon are extremely rare in adults.
Case Report:
A 38-year-old man presented to our clinic with severe right knee pain after falling down the stairs and abruptly bending the right knee. Plain radiographs of this knee showed tibial avulsion and a high riding patella, suggesting underlying Osgood-Schlatter disease, which was also present to a milder degree in the left knee. Magnetic resonance imaging confirmed an avulsion of the tibial tuberosity and showed concomitant avulsion of the patellar tendon without bone marrow edema. Computed tomography showed that the fragment of the tibial tuberosity had a dull-edged margin, and cortical bones were partially exposed. During surgery, the patellar tendon was divided into superficial and deep layers. The superficial layer was peeled from an attachment at the patella, while the deep layer was from the tibia and contained the fragment of the tibial tuberosity. The detached side of the fragment and tibia were coated with dense, fibrous tissue. Surgical repair was performed, with excellent outcomes. Radiographic and intraoperative findings suggested Osgood-Schlatter disease, which might cause avulsion of the tibial tuberosity.
Conclusion:
This is the first case of the bifocal proximal and distal rupture of the patellar tendon with the avulsion of the tibial tuberosity. Bifocal disruption of the patellar tendon should be considered in patients presenting with avulsion of the tibial tuberosity and suspected Osgood-Schlatter disease.
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10
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Moy A, Song E, Wallace SJ, Teixeira R, Torres D. Simultaneous Bilateral Patellar Tendon Rupture in a Young Adult Male: A Case Report and Review of the Literature. Cureus 2020; 12:e10649. [PMID: 33133819 PMCID: PMC7586418 DOI: 10.7759/cureus.10649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A bilateral patellar tendon rupture is extremely rare and has only been documented in case reports. Although the etiology remains unknown, predisposing factors include steroid usage, systemic diseases, and tendinopathies. In the present case, a healthy 33-year-old male with a prior history of bilateral patellar tendonitis and a diagnosis of Osgood-Schlatter disease during adolescence experienced simultaneous bilateral patellar tendon rupture after playing volleyball. He underwent bilateral patellar repair without complications. In the absence of trauma, spontaneous bilateral patellar tendon ruptures are associated with several predisposing factors, including systemic diseases, prior corticosteroid or fluoroquinolone usage, and history of tendinopathy. Injuries can be classified based on the location of the rupture. Bilateral patellar tendon ruptures can be misdiagnosed due to the rarity of cases and the lack of a normal comparative knee. Radiographic techniques can aid in the diagnosis, leading to early surgical treatment and improved outcomes. Early diagnosis and prompt surgical repair contribute to good functional outcomes in this potentially debilitating injury pattern.
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Affiliation(s)
- Adrian Moy
- Orthopedic Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Ethan Song
- Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Sean J Wallace
- Department of Surgery - Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
| | - Robert Teixeira
- Department of Surgery - Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA
| | - Daniel Torres
- Department of Surgery - Division of Orthopedic Surgery, Lehigh Valley Health Network, Allentown, USA
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11
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Bilateral patellar tendon rupture on lupus undergoing corticosteroids: a case report. BMC Musculoskelet Disord 2020; 21:477. [PMID: 32693777 PMCID: PMC7372875 DOI: 10.1186/s12891-020-03513-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patellar tendon rupture is a rare condition, especially when it is bilateral. The most frequent associated pathologies are systemic lupus erythematosus, chronic renal failure, or treatments like corticosteroids. The aim of this case report is to draw attention to the non-specific clinical aspect of this condition, to recall its radiological signs, and highlight the diagnostic contribution of musculoskeletal ultrasound. CASE PRESENTATION A 39-year-old man was diagnosed with a systemic lupus erythematosus with cutaneous, pulmonary, cardiac, hematological, renal, and immunological manifestations. He was treated with high-dose corticosteroids. Within 3 months he presented with a total functional impotence of the knees. On physical examination, there was a gap in the right infrapatellar region, his patellae were abnormally ascended, and his left knee was swollen. Insall-Salvati ratio on knees conventional radiographies was 2.5 in the right and 2.25 in the left knee, assessing bilateral patella alta. Ultrasound revealed a complete and bilateral patellar tendon rupture. The treatment consisted in a surgical repair and physiotherapy. The patient was able to mobilize independently after 6 months. CONCLUSIONS Bilateral patellar tendon rupture is exceptional. Systemic lupus erythematosus and corticosteroids are among trigger factors. Careful examination of the patellae should be done in front of knee extension deficit. Ultrasound plays a determining role in the diagnosis.
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12
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Lewis T, Zeisig E, Gaida JE. Does glucocorticoid exposure explain the association between metabolic dysfunction and tendinopathy? Endocr Connect 2020; 9:R36-R46. [PMID: 31967969 PMCID: PMC7040857 DOI: 10.1530/ec-19-0555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
Background While metabolic health is acknowledged to affect connective tissue structure and function, the mechanisms are unclear. Glucocorticoids are present in almost every cell type throughout the body and control key physiological processes such as energy homeostasis, stress response, inflammatory and immune processes, and cardiovascular function. Glucocorticoid excess manifests as visceral adiposity, dyslipidemia, insulin resistance, and type 2 diabetes. As these metabolic states are also associated with tendinopathy and tendon rupture, it may be that glucocorticoids excess is the link between metabolic health and tendinopathy. Objective To synthesise current knowledge linking glucocorticoid exposure to tendon structure and function. Methods Narrative literature review. Results We provide an overview of endogenous glucocorticoid production, regulation, and signalling. Next we review the impact that oral glucocorticoid has on risk of tendon rupture and the effect that injected glucocorticoid has on resolution of symptoms. Then we highlight the clinical and mechanistic overlap between tendinopathy and glucocorticoid excess in the areas of visceral adiposity, dyslipidemia, insulin resistance and type 2 diabetes. In these areas, we highlight the role of glucocorticoids and how these hormones might underpin the connection between metabolic health and tendon dysfunction. Conclusions There are several plausible pathways through which glucocorticoids might mediate the connection between metabolic health and tendinopathy.
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Affiliation(s)
- Trevor Lewis
- Physiotherapy Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Eva Zeisig
- Department of Surgical and Perioperative Sciences, Umeå Univerisity, Umeå, Sweden
| | - Jamie E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australian Capital Territory, Australia
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13
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Lamberti A, Loconte F, Spinarelli A, Baldini A. Bilateral Extensor Mechanism Allograft Reconstruction for Chronic Spontaneous Rupture: A Case Report and Review of the Literature. JBJS Case Connect 2019; 9:e0058. [PMID: 31140984 DOI: 10.2106/jbjs.cc.18.00058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 51-year-old woman, affected by end-stage renal disease, presented with 16-month-old ruptures of the right patellar tendon and the left quadriceps tendon. Since she had been nonambulatory for more than a year, the authors decided to perform a bilateral one-staged reconstruction with an Achilles tendon allograft on the right side and a full extensor mechanism allograft on the left side, achieving excellent clinical and functional results at 57 months' follow-up. CONCLUSIONS Bilateral spontaneous rupture of the extensor mechanism of the knee is a rare but dramatic occurrence. Allograft can be considered as a treatment option in case of chronic lesion or delayed reconstruction, with satisfactory midterm outcomes.
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Affiliation(s)
| | | | - Antonio Spinarelli
- Ospedale Policlinico Università di Bari, Piazza Giulio Cesare, Bari, Italy
| | - Andrea Baldini
- IFCA, Istituto Fiorentino di Cura e Assistenza, Florence, Italy
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14
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Berrigan W, Geer R, Jelnick JS, Davis JE, Bunning R. Visual Diagnosis: Quadriceps Tendon Rupture. J Emerg Med 2018; 55:563-564. [PMID: 30173963 DOI: 10.1016/j.jemermed.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/11/2018] [Indexed: 11/24/2022]
Affiliation(s)
- William Berrigan
- MedStar Georgetown University Hospital & MedStar National Rehabilitation Hospital, Washington, DC
| | - Roderick Geer
- MedStar Georgetown University Hospital & MedStar National Rehabilitation Hospital, Washington, DC
| | - James S Jelnick
- Department of Radiology, MedStar Washington Hospital Center, Washington, DC
| | - Jonathan E Davis
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC
| | - Robert Bunning
- MedStar Georgetown University Hospital & MedStar National Rehabilitation Hospital, Washington, DC
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15
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Schneider M, Angele P, Järvinen TA, Docheva D. Rescue plan for Achilles: Therapeutics steering the fate and functions of stem cells in tendon wound healing. Adv Drug Deliv Rev 2018; 129:352-375. [PMID: 29278683 DOI: 10.1016/j.addr.2017.12.016] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/01/2017] [Accepted: 12/22/2017] [Indexed: 02/07/2023]
Abstract
Due to the increasing age of our society and a rise in engagement of young people in extreme and/or competitive sports, both tendinopathies and tendon ruptures present a clinical and financial challenge. Tendon has limited natural healing capacity and often responds poorly to treatments, hence it requires prolonged rehabilitation in most cases. Till today, none of the therapeutic options has provided successful long-term solutions, meaning that repaired tendons do not recover their complete strength and functionality. Our understanding of tendon biology and healing increases only slowly and the development of new treatment options is insufficient. In this review, following discussion on tendon structure, healing and the clinical relevance of tendon injury, we aim to elucidate the role of stem cells in tendon healing and discuss new possibilities to enhance stem cell treatment of injured tendon. To date, studies mainly apply stem cells, often in combination with scaffolds or growth factors, to surgically created tendon defects. Deeper understanding of how stem cells and vasculature in the healing tendon react to growth factors, common drugs used to treat injured tendons and promising cellular boosters could help to develop new and more efficient ways to manage tendon injuries.
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Elattar O, Coleman SH, Warren RF, Rozbruch SR. Neglected Patellar Tendon Rupture With Massive Proximal Patellar Migration Treated With Patellar Transport and Staged Allograft Reconstruction: A Report of 2 Cases. Orthop J Sports Med 2016; 4:2325967116672175. [PMID: 27900337 PMCID: PMC5120681 DOI: 10.1177/2325967116672175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Osama Elattar
- Orthopedic Sports Medicine Service, University of Massachusetts, Worcester, Massachusetts, USA
| | - Struan H Coleman
- Sports Medicine Service, Hospital for Special Surgery, Weill Medical College, Cornell University, New York, New York, USA
| | - Russell F Warren
- Sports Medicine Service, Hospital for Special Surgery, Weill Medical College, Cornell University, New York, New York, USA
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service (LLCRS), Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College, Cornell University, New York, New York, USA
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18
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Rosa B, Campos P, Barros A, Karmali S, Gonçalves R. Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy. Clin Case Rep 2016; 4:678-81. [PMID: 27386128 PMCID: PMC4929805 DOI: 10.1002/ccr3.592] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/09/2016] [Accepted: 05/09/2016] [Indexed: 11/26/2022] Open
Abstract
The present case emphasizes the importance of adhering to strict indications when prescribing fluoroquinolones. Although rare, drug‐induced tendinopathy is not confined to fluoroquinolones. The patient's and physician's awareness should be increased to reduce fluoroquinolones‐associated morbidity, particularly in patients with previously described risk factors.
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Affiliation(s)
- Bárbara Rosa
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - Pedro Campos
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - André Barros
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - Samir Karmali
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
| | - Ricardo Gonçalves
- Hospital Vila Franca de Xira Estrada Nacional n°1, Povos 2600-009 Vila Franca de Xira Portugal
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Abstract
Ultrasonography (USG) is a safe, easily available, and cost-effective modality, which has the additional advantage of being real time for imaging and image-guided interventions of the musculoskeletal system. Musculoskeletal interventions are gaining popularity in sports and rehabilitation for rapid healing of muscle and tendon injuries in professional athletes, healing of chronic tendinopathies, aspiration of joint effusions, periarticular bursae and ganglia, and perineural injections in acute and chronic pain syndromes. This article aims to provide an overview of the spectrum of musculoskeletal interventions that can be done under USG guidance both for diagnostic and therapeutic purposes.
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Affiliation(s)
- Aditya Ravindra Daftary
- Department of InnoVision Imaging, Section of Musculoskeletal Imaging, Sportsmed Mumbai, Mumbai, Maharashtra, India
| | - Alpana Sudhir Karnik
- Department of InnoVision Imaging, Section of Musculoskeletal Imaging, Sportsmed Mumbai, Mumbai, Maharashtra, India
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Rosso F, Bonasia DE, Cottino U, Dettoni F, Bruzzone M, Rossi R. Patellar tendon: From tendinopathy to rupture. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:99-107. [PMID: 29264248 PMCID: PMC5730651 DOI: 10.1016/j.asmart.2015.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/07/2015] [Accepted: 07/03/2015] [Indexed: 01/08/2023]
Abstract
Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on the aetiology, diagnosis, and treatment of both patellar tendinopathy and rupture. We report the conservative treatments proposed for patellar tendinopathy and the surgical techniques described for its rupture.
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Affiliation(s)
- Federica Rosso
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico Hospital, Via Zuretti, Torino, Italy
| | - Umberto Cottino
- Department of Orthopedics and Traumatology, University of Study of Torino, Via Po 8, Torino, Italy
| | - Federico Dettoni
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Matteo Bruzzone
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Mauriziano Umberto I, Largo Turati 62, 10128, Torino, Italy.,Department of Orthopaedics and Traumatology, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico Hospital, Via Zuretti, Torino, Italy
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Seng C, Lim YJ, Pang HN. Spontaneous disruption of the bilateral knee extensor mechanism: a report of two cases. J Orthop Surg (Hong Kong) 2015; 23:262-6. [PMID: 26321566 DOI: 10.1177/230949901502300233] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous disruption of the knee extensor mechanism is associated with systemic diseases, steroid usage, and repeated microtrauma. Early repair or reconstruction is imperative for optimal outcome. We report 2 cases of spontaneous disruption of the bilateral knee extensor mechanism. The first patient had connective tissue disease and long-term steroid use. She had acute-on-chronic spontaneous bilateral patellar tendon rupture. She underwent reconstruction with an allograft and defunctioning wire. The second patient had end-stage renal failure with tertiary hyperparathyroidism and was on haemodialysis. He had a right patellar tendon rupture and a left quadriceps tendon rupture. He underwent primary repair of both tendons. Postoperatively, both patients followed a strict physiotherapy regimen and achieved good functional outcome.
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Affiliation(s)
- Chusheng Seng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yi-Jia Lim
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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22
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Takata Y, Nakase J, Numata H, Oshima T, Tsuchiya H. Repair and augmentation of a spontaneous patellar tendon rupture in a patient with Ehlers-Danlos syndrome: a case report. Arch Orthop Trauma Surg 2015; 135:639-44. [PMID: 25701458 DOI: 10.1007/s00402-015-2179-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Disruption of the knee extensor mechanism is a serious disorder that requires prompt treatment. It often occurs in the form of a patellar tendon rupture. It may occur in association with systemic disease or after administration of corticosteroids or fluoroquinolones. These conditions can cause tendon weakness, and consequent ruptures usually require both repair and augmentation. This paper reports on repair and augmentation for treating patellar tendon rupture in patients with Ehlers-Danlos syndrome (EDS). CASE REPORT We report a patellar tendon rupture in a 27-year-old man with EDS, which occurred in the midsubstance of the patella. As the patient has tendon weakness, extensive repair will increase the risk of patella baja, and the use of end-to-end suturing technique alone will not be enough to prevent a rupture recurring; however, augmentation could be used to address the tendon weakness. Repair of the rupture and augmentation with hamstring tendon was performed. One year after the surgery, the patient was able to move his knee joint without pain and had an active range of motion of 0° (passive 20°)-145°. He was able to perform a straight leg raise without an extension lag. CONCLUSIONS Repair and augmentation with hamstring tendon was an effective treatment option for patellar tendon rupture in a patient with EDS.
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Affiliation(s)
- Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan,
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Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use. Case Rep Orthop 2015; 2015:215796. [PMID: 25960904 PMCID: PMC4413034 DOI: 10.1155/2015/215796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/25/2015] [Indexed: 11/18/2022] Open
Abstract
Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release.
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25
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Divani K, Subramanian P, Tsitskaris K, Crone D, Lamba M. Bilateral patellar tendon rupture. JRSM SHORT REPORTS 2013; 4:2042533313499557. [PMID: 24319587 PMCID: PMC3831857 DOI: 10.1177/2042533313499557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Kiran Divani
- Trauma and Orthopaedics Department, Whipps Cross University Hospital, Leytonstone, London E11 1NR, UK
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26
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Jacobs JWG, Michels-van Amelsfort JMR. How to perform local soft-tissue glucocorticoid injections? Best Pract Res Clin Rheumatol 2013; 27:171-94. [PMID: 23731930 DOI: 10.1016/j.berh.2013.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammation of periarticular soft-tissue structures such as tendons, tendon sheaths, entheses, bursae, ligaments and fasciae is the hallmark of many inflammatory rheumatic diseases, but inflammation or rather irritation of these structures also occurs in the absence of an underlying rheumatic disease. In both these primary and secondary soft-tissue lesions, local glucocorticoid injection often is beneficial, although evidence in the literature is limited. This chapter reviews local injection therapy for these lesions and for nerve compression syndromes.
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Affiliation(s)
- J W G Jacobs
- Department of Rheumatology & Clinical Immunology, F02.127, University Medical Center Utrecht, Box 85500, 3508 GA Utrecht, The Netherlands.
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27
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Chen B, Li R, Zhang S. Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports. Knee 2012; 19:508-12. [PMID: 21835626 DOI: 10.1016/j.knee.2011.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 06/10/2011] [Accepted: 07/17/2011] [Indexed: 02/02/2023]
Abstract
Neglected rupture of the patellar tendon is rare but becomes more difficult to repair the longer it is left untreated. The most common rupture sites are the inferior pole of the patella and distal insertion. Proximal retraction of the patella and extensor mechanism adhesions makes the treatment more difficult than acute tendon rupture. We report two patients with neglected patellar tendon rupture treated by reconstruction and restoration using semitendinosus-gracilis (STG) tendons with preserved distal insertions. Preserved distal insertion provided sufficient blood supply to accelerate healing, while combined fixation with tension-reducing wire, offered the initial stability of the closed-loop sutured tendon. Both patients reacquired near normal strength and stability of the patellar tendon and restoration of function after operation and rehabilitation.
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Affiliation(s)
- Bin Chen
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China.
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28
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Patellar Tendon Rupture with Underlying Systemic Lupus Erythematosus: A Case Report. J Emerg Med 2012; 43:e35-8. [DOI: 10.1016/j.jemermed.2009.08.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/04/2009] [Accepted: 08/08/2009] [Indexed: 11/17/2022]
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Distal partial ruptures of triceps brachii tendon in an athlete. Orthop Traumatol Surg Res 2012; 98:242-6. [PMID: 22381568 DOI: 10.1016/j.otsr.2011.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 06/24/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
Distal brachii triceps tendon rupture is rare. Partial lesions are not so well defined. If functionally they are well tolerated in patients with low functional demand, management guideline is not so clear for sportsmen. To our best knowledge, there is no reported technique for the repair of partial forms. A 28-year-old patient was operated on for a partial triceps rupture. He underwent a transosseous olecranon suture of the tricipital tendon, with a side-to-side suture to the healthy residual tendon. The patient was assessed at 2 years follow-up with the DASH score. He had painless and mobile elbow with no effusion and returned to sport 4 months after his surgical repair. The extension strength was comparable to the healthy side (5/5). The DASH score was 1,7 for global score, and 6,3 for work and sport modules. Partial rupture of brachii triceps tendon is not well tolerated in high functional demand patients. We think that patients should be operated in these situations and may achieve excellent results. Postoperative management is crucial to achieve good results as well as in complete rupture.
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30
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Spontaneous rupture of the patellar tendon and the contralateral quadriceps tendon, associated with lupus erythematosus: analysis of the literature. Case Rep Orthop 2012. [PMID: 23198218 PMCID: PMC3504210 DOI: 10.1155/2011/569363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bilateral rupture of the patellar tendon is a rare injury. A case of a 67-year-old man with systemic lupus erythematosus under corticosteroid treatment for the last 10 years, who sustained spontaneous rupture of the patellar tendon and the contralateral quadriceps tendon, is herein presented. The patient was operated bilaterally, had an optimal outcome considering his age and the comorbidities, and was followed up for 24 months.
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31
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Kolovich GP, Griesser MJ, Davis C, Granger JF. Asymptomatic Bilateral Patella Alta After Surgical Repair of Traumatic, Sequential Bilateral Patellar Tendon Rupture: A Case Report. JBJS Case Connect 2011; 1:e8. [PMID: 29252224 DOI: 10.2106/jbjs.cc.k.00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Gregory P Kolovich
- Department of Orthopaedics, The Ohio State University, 4110 Cramblett Hall, 456 West 10th Avenue, Columbus, Ohio 43210.
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32
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Concurrent bilateral patellar tendon rupture in a preadolescent athlete: a case report and review of the literature. J Pediatr Orthop B 2010; 19:511-4. [PMID: 20595921 DOI: 10.1097/bpb.0b013e32833cb7a0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Concurrent bilateral patellar tendon rupture in preadolescence is a very rare condition. It is mostly associated with systemic disease or steroid use in adults. We report a case of 12-year-old boy, who had bilateral patellar tendon rupture, treated with nonabsorbable synthetic suturing with titanium osseous anchors. Moreover, we discuss the causes of patellar tendon rupture, diagnostic clues and surgical options.
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33
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Del Cura J, Zabala R, Corta I. Intervencionismo guiado por ecografía en el sistema musculoesquelético. RADIOLOGIA 2010; 52:525-33. [DOI: 10.1016/j.rx.2010.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/07/2010] [Accepted: 07/16/2010] [Indexed: 12/01/2022]
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Iacono V, Cigala F, Fazioli F, Rosa D, Maffulli N. Reconstruction of chronic patellar tendon tear with allograft in a patient with Ehlers-Danlos syndrome. Knee Surg Sports Traumatol Arthrosc 2010; 18:1116-8. [PMID: 20033670 DOI: 10.1007/s00167-009-1022-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 11/27/2009] [Indexed: 11/24/2022]
Abstract
Failure of repair of the patellar tendon is uncommon. It may occur in association with chronic systemic diseases or after administration of corticosteroid and quinolones. We report the reconstruction of the patellar tendon with allograft, after failed primary repair, of a 23-year-old young with Ehlers-Danlos syndrome.
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Affiliation(s)
- Venanzio Iacono
- Department of Orthopaedics, Faculty of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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35
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Savarese E, Bisicchia S, Amendola A. Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the literature. Musculoskelet Surg 2010; 94:81-8. [PMID: 20480273 DOI: 10.1007/s12306-010-0077-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 04/06/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Eugenio Savarese
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, Rome, Italy.
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36
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del Cura J, Zabala R, Corta I. Ultrasound-guided interventional procedures in the musculoskeletal system. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70026-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252:647-61. [PMID: 19717750 DOI: 10.1148/radiol.2523081929] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Corticosteroids and local anesthetics are some of the most commonly administered medications in radiology departments. These medications have marked variability in their formulations, which may increase their adverse event profile for specific procedures. In particular, certain corticosteroid preparations are associated with adverse central nervous system (CNS) sequelae. This is most likely due to distal embolization by particulate formulations. Nonparticulate steroid formulations are not associated with such events. Local anesthetics have severe CNS and cardiac adverse effects if injected intravascularly and have recently been associated with intraarticular chondrolysis if used in large doses. This review discusses these medications with particular emphasis on their established and postulated adverse effects. The administering radiologist should be aware of these potential effects and how best to reduce their occurrence.
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Affiliation(s)
- Peter J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
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38
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39
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Taylor BC, Tancev A, Fowler T. Bilateral patellar tendon rupture at different sites without predisposing systemic disease or steroid use. THE IOWA ORTHOPAEDIC JOURNAL 2009; 29:100-104. [PMID: 19742095 PMCID: PMC2723702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Simultaneous bilateral patellar tendon ruptures are extremely rare, and even more rare in patients without systemic disease. We describe bilateral simultaneous patellar tendon disruptions in the absence of systemic disease or steroid usage, with one tendon disruption at the inferior pole and the other an intrasubstance tear. The different locations of the ruptures are also exceedingly rare, as only two cases of non-identical ruptures have ever been reported. We also review all bilateral patellar tendon rupture case reports from English and German literature.
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Affiliation(s)
- Benjamin C Taylor
- Department of Orthopaedic Surgery, Mount Carmel Medical Center, Columbus, Ohio, USA.
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40
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LaPrade RF, Griffith CJ, Gilbert TJ. Intrasubstance stretch tear of a preadolescent patellar tendon with reconstruction using autogenous hamstrings. Am J Sports Med 2008; 36:1410-3. [PMID: 18326834 DOI: 10.1177/0363546508314731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Robert F LaPrade
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, R200, Minneapolis, MN 55454, USA.
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41
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Louis LJ. Musculoskeletal Ultrasound Intervention: Principles and Advances. Radiol Clin North Am 2008; 46:515-33, vi. [DOI: 10.1016/j.rcl.2008.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Kovacevic D, Rodeo SA. Biological augmentation of rotator cuff tendon repair. Clin Orthop Relat Res 2008; 466:622-33. [PMID: 18264850 PMCID: PMC2505220 DOI: 10.1007/s11999-007-0112-4] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 12/31/2007] [Indexed: 02/08/2023]
Abstract
A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery.
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Affiliation(s)
- David Kovacevic
- Laboratory for Soft Tissue Research, The Hospital for Special Surgery, New York, NY USA
| | - Scott A. Rodeo
- Sports Medicine and Shoulder Service, The Hospital for Special Surgery, 525 East 71st St., New York, NY 10021 USA
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Papanikolaou A, Charalambides C, Thanassas C. Letter to the Editor. Spontaneous simultaneous bilateral patellar tendon rupture in a systemic lupus erythematosus patient. Lupus 2008; 16:915-7. [PMID: 17971367 DOI: 10.1177/0961203307081911] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Moretti B, Notarnicola A, Moretti L, Garofalo R, Patella V. Spontaneous bilateral patellar tendon rupture: a case report and review of the literature. ACTA ACUST UNITED AC 2008; 91:51-5. [DOI: 10.1007/s12306-007-0009-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 11/02/2007] [Indexed: 11/28/2022]
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Cree C, Pillai A, Jones B, Blyth M. Bilateral patellar tendon ruptures: a missed diagnosis : case report and literature review. Knee Surg Sports Traumatol Arthrosc 2007; 15:1350-4. [PMID: 17604980 DOI: 10.1007/s00167-007-0350-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 04/11/2007] [Indexed: 11/26/2022]
Abstract
Knee extensor mechanism disruption is an unusual but serious emergency presentation. Rarely disruption can occur within the patellar tendon which is often associated with systemic diseases such as rheumatoid arthritis and systemic lupus erythematosus. Surgical management is required to repair the patellar tendon after clinical assessment and diagnosis. We describe the case of a 75-year-old man without any known predisposing systemic disease presenting on several occasions before accurate diagnosis and treatment. We include a literature review of similar cases and discuss the importance of missed diagnosis and underlying causes. A treatment algorithm to avoid missing similar injuries is also proposed.
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Affiliation(s)
- Calum Cree
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow G40SF, UK
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Muratli HH, Celebi L, Hapa O, Biçimoğlu A. Simultaneous rupture of the quadriceps tendon and contralateral patellar tendon in a patient with chronic renal failure. J Orthop Sci 2006; 10:227-32. [PMID: 15815873 DOI: 10.1007/s00776-004-0868-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Accepted: 11/25/2004] [Indexed: 11/27/2022]
Abstract
Simultaneous quadriceps and patellar tendon rupture is rare. Mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor traumas. We present a case of simultaneous quadriceps and patellar tendon rupture in a 21-year-old man with chronic renal failure in this report. He was treated surgically by osseotendinous repair with suture anchors and supplemental cerclage wire fixation on both sides. He regained his normal knee joint functions 18 months after the operation.
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Affiliation(s)
- Hasan Hilmi Muratli
- Ankara Numune Education and Research Hospital, Third Orthopedics and Traumatology Clinic, Ankara, Turkey
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Sierra RJ, Weiss NG, Shrader MW, Steinmann SP. Acute triceps ruptures: case report and retrospective chart review. J Shoulder Elbow Surg 2006; 15:130-4. [PMID: 16414484 DOI: 10.1016/j.jse.2005.01.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Accepted: 01/29/2005] [Indexed: 02/01/2023]
Affiliation(s)
- Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Muratli HH, Celebi L, Hapa O, Biçimoğlu A. Bilateral patellar tendon rupture in a child: a case report. Knee Surg Sports Traumatol Arthrosc 2005; 13:677-82. [PMID: 15924247 DOI: 10.1007/s00167-005-0620-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Accepted: 11/25/2004] [Indexed: 11/27/2022]
Abstract
Patellar tendon rupture in children is very rare. When it occurs, patellar tendon is usually ruptured either from the upper end as a sleeve fracture of the patella or from lower end as an avulsion fracture of the tibial tuberosity. In this report, we present the case of an otherwise healthy 9-years-old boy who had subsequent bilateral patellar tendon ruptures through the midparts, which has not been published previously in the literature. Treatment was performed with primary end-to-end repair, reinforcement with cerclage wires and fresh-frozen achilles tendon augmentation for both sides.
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Affiliation(s)
- Hasan Hilmi Muratli
- 3rd Orthopedics and Traumatology Clinic, Ankara Numune Education and Research Hospital, 100.YilMahallesi, 32.Cadde, KardelenSitesi, ABlok.Daire:1, Balgat, Ankara, Turkey.
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Kellersmann R, Blattert TR, Weckbach A. Bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report and review of the literature. Arch Orthop Trauma Surg 2005; 125:127-33. [PMID: 15645271 DOI: 10.1007/s00402-004-0782-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Indexed: 10/25/2022]
Abstract
Simultaneous bilateral patella tendon ruptures are very rare injuries of the knee extensor complex often associated with systemic disorders such as lupus erythematosus or rheumatoid arthritis. We describe the case of a 34-year-old man without concomitant systemic disease or steroid use and provide the most comprehensive review of the German and English literature. Furthermore, we discuss the predisposing factors and causal mechanisms as well as current diagnostic procedures and treatment options. In the literature review, only a few patients without systemic disorder or steroid medication present with potential predisposing factors that may be responsible for degenerative changes of the patella tendon, weakening its stability. In addition, in most of these cases, it remains difficult to explain the bilateral and simultaneous nature of this injury.
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Affiliation(s)
- Richard Kellersmann
- Trauma and Reconstructive Surgery, Würzburg University Hospital, Würzburg, Germany.
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Abstract
Certain similarities can clearly be appreciated between Achilles and patellar tendon ruptures. Both are strong tendons that transmit force bridging at least one joint of the lower limb. When healthy, both require massive forces to be disrupted, and both can be weakened through certain systemic disease processes, steroids, and fluoroquinones. Both allow for a variety of innovative management possibilities that ultimately lend themselves to individual surgical preference. We feel that, although surgical management plays an important role in restoring continuity in knee extension and in plantar flexion, functional outcome inevitably relies on patient motivation and a well-established physiotherapy regime. Sports physicians should be able to identify both conditions early in their presentation, but still hold a high index of suspicion for these problems in athletes who have an acute exacerbation of ongoing tendinopathy.
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Affiliation(s)
- Nicola Maffulli
- Department of Trauma and Orthopaedics, Keele University School of Medicine, Thornburrow Drive, Hartshill ST47QB, UK.
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